National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/14/2022 release of VAERS data:

This is VAERS ID 337243

Government Disclaimer on use of this data



Case Details

VAERS ID: 337243 (history)  
Form: Version 1.0  
Age: 0.44  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2008-12-11
Onset:2008-12-16
   Days after vaccination:5
Submitted: 2009-01-09
   Days after onset:24
Entered: 2009-01-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2957AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF4U5AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0217X / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Encephalopathy, Shock haemorrhagic
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypovolaemic shock conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-12-18
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: See attached. Labs and Diagnostics: CBC with 43K WBCs with 20% atypical lymphs. CT brain scan (+) cerebral edema and probable ischemic infarcts. CSF (+) for few PMNs, CSF glucose 105, CSF protein 62. CSF cx (-). EEG abnormal. Rotavirus (+), likely due to shedding. ALT 938-9,480. AST 1,974-12,822. Blood cx (-). UC (-). Hgb 9.2. Platelets WNL on admission down to 105K. Lactate 5.3 on adm up to 10.2. PT 36.3-49.5. INR 3.54-5.22. PTT 42-56. Fibrinogen dropped from 153-137. D-dimer $g 20. CXR (+) for atelectasis. K+ 6.1. CO2 12. Cl- 110. Glucose 55.
CDC Split Type:

Write-up: Patient developed hemorrhagic shock w/ encephalopathy syndrome 5 days after vaccine administration and died. 1/27/2009 MR received for DOS 12/16-18/2008 which was the Date of death. Principal DX: Multisystem organ failure 2'' to Hemorrhagic Shock and Encephalopathy Syndrome (HSES). Pt initially presented with new onset seizures and diarrhea. Pt in usual state of good health a.m. of 1/16/09 except for some recent mild congestion. Later noted to be sweaty and did not respond while parent was changing clothes. Later noted to be eye rolling and making unusual movements. In status epilepticus and metabolic acidosis on arrivial in local ED. Intubated and medicated for seizures and transferred to higher level of care. Cool and mottled on arrival. LFTs elevated. Issues with hypoglycemia, abnormal coags and electrolyte fluctuations with little response to tx. Parents elected to withdraw life support follwing notification of fatal status of illness. 2/12/09 Death Cert received. COD- Multiorgan Failure. Hemorrhagic Shock and Encephalopathy Syndrome.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=337243


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166